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Medical Surgical Nursing - Endocrine Problems

Endocrine System


Set 1 – Endocrine System Assessment


1. A young adult patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory test results to show

a.

increased urinary cortisol.

c.

elevated serum aldosterone levels.

b.

decreased serum thyroxine.

d.

low urinary catecholamines excretion.


ANS: A

Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid-stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.



2. Which statement by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be necessary?

a.

“I notice my breasts are tender lately.”

b.

“I am so thirsty that I drink all day long.”

c.

“I get up several times at night to urinate.”

d.

“I feel a lump in my throat when I swallow.”


ANS: D

Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.



3. A patient seen in the emergency department for severe headache and acute confusion has a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test?

a.

Urinary 17-ketosteroids

b.

Antidiuretic hormone level

c.

Growth hormone stimulation test

d.

Adrenocorticotropic hormone level


ANS: B

Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patient’s hyponatremia.

4. Which question from a nurse during a patient interview will provide focused information about a possible thyroid disorder?

a.

“What methods do you use to help cope with stress?”

b.

“Have you experienced any blurring or double vision?”

c.

“Have you had a recent unplanned weight gain or loss?”

d.

“Do you have to get up at night to empty your bladder?”


ANS: C

Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.



5. A patient will be scheduled in the outpatient clinic for blood cortisol testing. Which instruction will the nurse provide?

a.

“Avoid adding any salt to your foods for 24 hours before the test.”

b.

“You will need to lie down for 30 minutes before the blood is drawn.”

c.

“Come to the laboratory to have the blood drawn early in the morning.”

d.

“Do not have anything to eat or drink before the blood test is obtained.”


ANS: C

Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.



6. A 61-yr-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels.

a.

calcitonin

c.

thyroid hormone

b.

catecholamine

d.

parathyroid hormone


ANS: D

Parathyroid hormone (PTH) is the major controller of blood calcium levels. Although calcitonin secretion is a countermechanism to PTH, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.



7. During the nurse’s physical examination of a young adult, the patient’s thyroid gland cannot be felt. The most appropriate action by the nurse is to

a.

palpate the patient’s neck more deeply.

b.

document that the thyroid was nonpalpable.

c.

notify the health care provider immediately.

d.

teach the patient about thyroid hormone testing.

ANS: B

The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid-stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.



8. Which laboratory value should the nurse review to determine whether a patient’s hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland?

a.

Thyroxine (T4) level

b.

Triiodothyronine (T3) level

c.

Thyroid-stimulating hormone (TSH) level

d.

Thyrotropin-releasing hormone (TRH) level


ANS: C

A low TSH level indicates that the patient’s hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.



9. The nurse reviews a patient’s glycosylated hemoglobin (A1C) results to evaluate

a.

fasting preprandial glucose levels.

b.

glucose levels 2 hours after a meal.

c.

glucose control over the past 90 days.

d.

hypoglycemic episodes in the past 3 months.


ANS: C

Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.



10. A patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for

a.

increased serum sodium.

c.

elevated serum potassium.

b.

decreased urinary output.

d.

evidence of fluid overload.


ANS: C

Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.



11. A patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease?

a.

Ideal weight

c.

Activity level

b.

Value system

d.

Visual changes


ANS: B

When dealing with a patient with a chronic condition such as diabetes, identification of the patient’s values and beliefs can assist the interprofessional team in choosing strategies for successful lifestyle change. The other information also will be useful but is not as important in developing an individualized plan for the necessary lifestyle changes.



12. An 18-yr-old male patient with small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain

a.

ice in a basin.

c.

a cardiac monitor.

b.

glargine insulin.

d.

50% dextrose solution.


ANS: D

Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.



13. The nurse will plan to teach a patient to minimize physical and emotional stress while the patient is undergoing

a.

a water deprivation test.

b.

testing for serum T3 and T4 levels.

c.

a 24-hour urine test for free cortisol.

d.

a radioactive iodine (I-131) uptake test.


ANS: C

Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.




14. The nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to

a.

insert and maintain a retention catheter.

b.

keep the specimen refrigerated or on ice.

c.

drink at least 3 L of fluid during the 24 hours.

d.

void and save that specimen to start the collection.


ANS: B

The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.



15. Which additional information will the nurse need to consider when reviewing the laboratory results for a patient’s total calcium level?

a.

The blood glucose

c.

The phosphate level

b.

The serum albumin

d.

The magnesium level


ANS: B

Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.



16. A patient is admitted with tetany. Which laboratory value should the nurse plan to monitor?

a.

Total protein

c.

Ionized calcium

b.

Blood glucose

d.

Serum phosphate


ANS: C

Tetany is associated with hypocalcemia. The other values would not be useful for this patient.


17. Which information about a patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test?

a.

The patient reports having occasional orthostatic dizziness.

b.

The patient takes oral corticosteroids for rheumatoid arthritis.

c.

The patient has had a 10-lb weight gain in the last month.

d.

The patient drank several glasses of water an hour previously.


ANS: B

Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

18. A registered nurse (RN) is caring for a patient with a goiter and possible hyperthyroidism. Which action by the RN indicates that the charge nurse needs to provide the RN with additional teaching?

a.

The RN checks the blood pressure in both arms.

b.

The RN palpates the neck to assess thyroid size.

c.

The RN orders saline eye drops to lubricate the patient’s bulging eyes.

d.

The RN lowers the thermostat to decrease the temperature in the room.


ANS: B

Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.



19. The nurse is caring for a 45-yr-old male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider?

a.

The patient complains of intense thirst.

b.

The patient has a 5-lb (2.3-kg) weight loss.

c.

The patient’s urine osmolality does not increase.

d.

The patient feels dizzy when sitting on the edge of the bed.


ANS: B

A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.



20. A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is important for the nurse to communicate to the health care provider before the test?

a.

Bilateral poor peripheral vision

c.

Recent weight loss of 20 lb

b.

Allergies to iodine and shellfish

d.

Complaint of ongoing headaches


ANS: B

Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.



21. The nurse is caring for a 63-yr-old with a possible pituitary tumor who is scheduled for a computed tomography scan with contrast. Which information about the patient is important to discuss with the health care provider before the test?

a.

History of renal insufficiency

b.

Complains of chronic headache

c.

Recent bilateral visual field loss

d.

Blood glucose level of 134 mg/dL


ANS: A

Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as IV fluids to prevent this complication. The other findings are consistent with the patient’s diagnosis of a pituitary tumor.



MULTIPLE RESPONSE


1. Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)?

a.

“You will need to avoid smoking before the test.”

b.

“Exercise should be avoided until the testing is complete.”

c.

“Several blood samples will be obtained during the testing.”

d.

“You should follow a low-calorie diet the day before the test.”

e.

“The test requires that you fast for at least 8 hours before testing.”


ANS: A, C, E

Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.


















Set 2 - Endocrine System Assessment


1. A nurse cares for a client who is prescribed a drug that blocks a hormone’s receptor site. Which therapeutic effect should the nurse expect? a. Greater hormone metabolism b. Decreased hormone activity c. Increased hormone activity d. Unchanged hormone response ANS: B Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell’s response is the same as when the level of the hormone is decreased.



2. A nurse cares for a client with a deficiency of aldosterone. Which assessment finding should the nurse correlate with this deficiency? a. Increased urine output b. Vasoconstriction c. Blood glucose of 98 mg/dL d. Serum sodium of 144 mEq/L ANS: A Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Vasoconstriction is not related. These sodium and glucose levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia.



3. A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess? a. Potassium b. Sodium c. Calcium d. Magnesium ANS: C Parafollicular cells produce thyrocalcitonin (calcitonin), which regulates serum calcium levels. Calcitonin has no impact on potassium, sodium, or magnesium balances.



4. A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding should alert the nurse to urgently contact the health care provider? a. Heart rate of 50 beats/min b. Respiratory rate of 18 breaths/min c. Oxygenation saturation of 92% d. Blood pressure of 144/69 mm Hg ANS: A Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication. The other vital signs are within normal limits and do not indicate a negative response to the medication.



5. A nurse prepares to palpate a client’s thyroid gland. Which action should the nurse take when performing this assessment? a. Stand in front of the client instead of behind the client. b. Ask the client to swallow after palpating the thyroid. c. Palpate the right lobe with the nurse’s left hand. d. Place the client in a sitting position with the chin tucked down. ANS: D The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.



6. A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is prescribed a 24-hour urine specimen collection. Which statement should the nurse include when delegating this activity to the UAP? a. “Note the time of the client’s first void and collect urine for 24 hours.” b. “Add the preservative to the container at the end of the test.” c. “Start the collection by saving the first urine of the morning.” d. “It is okay if one urine sample during the 24 hours is not collected.” ANS: A The collection of a 24-hour urine specimen is often delegated to a UAP. The nurse must ensure that the UAP understands the proper process for collecting the urine. The 24-hour urine collection specimen is started after the client’s first urination. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the client’s first void is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. All urine samples need to be collected for the test results to be accurate.

7. A nurse assesses a female client who presents with hirsutism. Which question should the nurse ask when assessing this client? a. “How do you plan to pay for your treatments?” b. “How do you feel about yourself?” c. “What medications are you prescribed?” d. “What are you doing to prevent this from happening?” ANS: B Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should inquire into the client’s body image and self-perception. Asking about the client’s financial status or current medications does not address the client’s immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.



8. A nurse teaches a client who has been prescribed a 24-hour urine collection to measure excreted hormones. The client asks, “Why do I need to collect urine for 24 hours instead of providing a random specimen?” How should the nurse respond? a. “This test will assess for a hormone secreted on a circadian rhythm.” b. “The hormone is diluted in urine; therefore, we need a large volume.” c. “We are assessing when the hormone is secreted in large amounts.” d. “To collect the correct hormone, you need to urinate multiple times.” ANS: A Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection that occurs over 24 hours will most accurately reflect hormone secretion. Dilution of hormones in urine, secretion of hormone amounts, and ability to collect the correct hormone are not reasons to complete a 24-hour urine test.



9. A nurse plans care for an older adult who is admitted to the hospital for pneumonia. The client has no known drug allergies and no significant health history. Which action should the nurse include in this client’s plan of care? a. Initiate Airborne Precautions. b. Offer fluids every hour or two. c. Place an indwelling urinary catheter. d. Palpate the client’s thyroid gland. ANS: B A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more diluted urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with simple pneumonia would not require Airborne Precautions. Indwelling urinary catheterization is not necessary for this client and would increase the client’s risk for infection. The nurse should plan a toileting schedule and assist the client to the bathroom if needed. Palpating the client’s thyroid gland is a part of a comprehensive examination but is not specifically related to this client.



10. A nurse cares for a client who is prescribed a 24-hour urine collection. The unlicensed assistive personnel (UAP) reports that, while pouring urine into the collection container, some urine splashed his hand. Which action should the nurse take next? a. Ask the UAP if he washed his hands afterward. b. Have the UAP fill out an incident report. c. Ask the laboratory if the container has preservative in it. d. Send the UAP to Employee Health right away. ANS: A For safety, the nurse should find out if the UAP washed his or her hands. The UAP should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the UAP is washing hands, if needed. The UAP would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The UAP also needs further education on Standard Precautions, which include wearing gloves.



11. A nurse evaluates laboratory results for a male client who reports fluid secretion from his breasts. Which hormone value should the nurse assess first? a. Posterior pituitary hormones b. Adrenal medulla hormones c. Anterior pituitary hormones d. Parathyroid hormone ANS: C Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones would not cause fluid secretion from the client’s breast.



12. A nurse cares for a client who has excessive catecholamine release. Which assessment finding should the nurse correlate with this condition? a. Decreased blood pressure b. Increased pulse c. Decreased respiratory rate d. Increased urine output ANS: B Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.

13. A nurse assesses a client diagnosed with adrenal hypofunction. Which client statement should the nurse correlate with this diagnosis? a. “I have a terrible craving for potato chips.” b. “I cannot seem to drink enough water.” c. “I no longer have an appetite for anything.” d. “I get hungry even after eating a meal.” ANS: A The nurse correlates a client’s salt craving with adrenal hypofunction. Excessive thirst is related to diabetes insipidus or diabetes mellitus. Clients who have hypothyroidism often have a decrease in appetite. Excessive hunger is associated with diabetes mellitus.



14. A nurse teaches an older adult with a decreased production of estrogen. Which statement should the nurse include in this client’s teaching to decrease injury? a. “Drink at least 2 liters of fluids each day.” b. “Walk around the neighborhood for daily exercise.” c. “Bathe your perineal area twice a day.” d. “You should check your blood glucose before meals.” ANS: B An older adult client with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse should encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not decrease injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.



15. A nurse cares for a client who is prescribed a serum catecholamine test. Which action should the nurse take when obtaining the sample? a. Discard the first sample and then begin the collection. b. Draw the blood sample after the client eats breakfast. c. Place the sample on ice and send to the laboratory immediately. d. Add preservatives before sending the sample to the laboratory. ANS: C A blood sample for catecholamine must be placed on ice and taken to the laboratory immediately. This sample is not urine, and therefore the first sample should not be discarded nor should preservatives be added to the sample. The nurse should use the appropriate tube and obtain the sample based on which drugs are administered, not dietary schedules.



MULTIPLE RESPONSE

1. A nurse cares for clients with hormone disorders. Which are common key features of hormones? (Select all that apply.) a. Hormones may travel long distances to get to their target tissues. b. Continued hormone activity requires continued production and secretion. c. Control of hormone activity is caused by negative feedback mechanisms. d. Most hormones are stored in the target tissues for use later. e. Most hormones cause target tissues to change activities by changing gene activity. ANS: A, B, C Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body’s needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity.



2. A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones should the nurse expect to be affected by this condition? (Select all that apply.) a. Thyroid-stimulating hormone b. Vasopressin c. Follicle-stimulating hormone d. Calcitonin e. Growth hormone ANS: A, C, E Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.



3. A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine disorder? (Select all that apply.) a. Excessive thyroid-stimulating hormone – Increased bone formation b. Excessive melanocyte-stimulating hormone – Darkening of the skin c. Excessive parathyroid hormone – Synthesis and release of corticosteroids d. Excessive antidiuretic hormone – Increased urinary output e. Excessive adrenocorticotropic hormone – Increased bone resorption ANS: A, B Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte-stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.




Set 3 – Endocrine Disorders


1. The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimoto’s thyroiditis. When assessing this patient, what sign or symptom would the nurse expect?

A) Fatigue

B) Bulging eyes

C) Palpitations

D) Flushed skin

Ans: A

Feedback:

Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.



2. A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient?

A) Side-lying (lateral) with one pillow under the head

B) Head of the bed elevated 30 degrees and no pillows placed under the head

C) Semi-Fowler’s with the head supported on two pillows

D) Supine, with a small roll supporting the neck

Ans: C

Feedback:

When moving and turning the patient, the nurse carefully supports the patient’s head and avoids tension on the sutures. The most comfortable position is the semi-Fowler’s position, with the head elevated and supported by pillows.



3. A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications?

A) Do you feel any muscle twitches or spasms?

B) Do you feel flushed or sweaty?

C) Are you experiencing any dizziness or lightheadedness?

D) Are you having any pain that seems to be radiating from your bones?

Ans: A

Feedback:

As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.

4. The nurse is caring for a patient with a diagnosis of Addison’s disease. What sign or symptom is most closely associated with this health problem?

A) Truncal obesity

B) Hypertension

C) Muscle weakness

D) Moon face

Ans: C

Feedback:

Patients with Addison’s disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Patients with Cushing syndrome demonstrate truncal obesity, “moon” face, acne, abdominal striae, and hypertension.



5. The nurse is caring for a patient with Addison’s disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic?

A) The possibility of precipitous weight gain

B) The need for lifelong steroid replacement

C) The need to match the daily steroid dose to immediate symptoms

D) The importance of monitoring liver function

Ans: B

Feedback:

Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the patient and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.



6. The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body?

A) Eggs

B) Shellfish

C) Table salt

D) Red meat

Ans: C

Feedback:

The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.



7. A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy?

A) The patient’s diet should be low protein with ample fat.

B) The patient may experience short-term changes in cognition.

C) The patient is at an increased risk for developing infection.

D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.

Ans: C

Feedback:

The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.



8. A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?

A) Glucose in the urine

B) Albumin in the urine

C) Highly dilute urine

D) Leukocytes in the urine

Ans: C

Feedback:

Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.



9. The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?

A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours

B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands

C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning

D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered

Ans: C

Feedback:

Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.



10. You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan?

A) Risk for injury related to weakness

B) Ineffective breathing pattern related to muscle weakness

C) Risk for loneliness related to disturbed body image

D) Autonomic dysreflexia related to neurologic changes

Ans: A

Feedback:

The nursing priority is to decrease the risk of injury by establishing a protective environment. The patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners or furniture. The patient’s breathing will not be affected and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an issue for the patient, but safety is a priority.



11. The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the nurse include? Select all that apply.

A) Urine output

B) Signs or symptoms of venous thromboembolism

C) Peripheral pulses

D) Blood pressure

E) Skin integrity

Ans: A, D

Feedback:

The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP. The patient’s peripheral pulses, risk of VTE, and skin integrity are not typically affected by aldosteronism.



12. The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the body’s natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids?

A) In the evening between 4 PM and 6 PM

B) Prior to going to sleep at night

C) At noon every day

D) In the morning between 7 AM and 8 AM

Ans: D

Feedback:

In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.



13. A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patient’s history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following?

A) Increase his intake of sodium until the GI symptoms improve.

B) Increase his intake of potassium until the GI symptoms improve.

C) Increase his intake of glucose until the GI symptoms improve.

D) Increase his intake of calcium until the GI symptoms improve.

Ans: A

Feedback:

The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.



14. The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote?

A) Complete bed rest

B) Bed rest with bathroom privileges

C) Out of bed (OOB) to the chair twice a day

D) Ambulation and activity as tolerated

Ans: D

Feedback:

Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Best rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to getting out of bed only a few times a day also inc